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UK sees a fall in maternal deaths

Maternal deaths in the UK have dropped from 11 per 100,000 women giving birth in 2006–08 to 10 per 100,000 women giving birth in 2010–12*, according to a national report from a team of academics, clinicians and charity representatives called MBRRACE-UK which is led from the National Perinatal Epidemiology Unit, University of Oxford**.

Their report, commissioned by the Healthcare Quality Improvement Partnership as part of the Clinical Outcome Review Programmes***, forming the 2009–2012 UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity, included all 357 cases of women in Britain who died during or within 6 weeks of the end of their pregnancy in those four years.

The researchers found that the decrease in maternal deaths is statistically significant, and has been driven by a reduction in deaths due to pregnancy complications such as eclampsia, blood loss or blood clots – continuing a 10 year trend.

However, the majority of women who died during or within 6 weeks of the end of their pregnancy died from other medical conditions, such as heart disease, neurological conditions or mental health problems.

Two-thirds of mothers died from these indirect causes rather than pregnancy complications, and the rate of indirect deaths has not come down in the past 10 years.

Furthermore, three-quarters of women who died had pre-existing medical and mental health problems before they became pregnant.

The Oxford University researchers say there are key areas that the health service can look to improve in order to reduce the number of maternal deaths from these indirect causes.

The report says that women with pre-existing conditions need better pre-pregnancy advice as well as joint specialist and maternity care through pregnancy and birth.

‘There is a need, above all, for coordinated and concerted action at all levels to improve the care of women with medical complications before, during and after pregnancy,’ says Professor Marian Knight of the National Perinatal Epidemiology Unit at Oxford University, who led the enquiry.

She adds: ‘It is important to remember that deaths are very rare. They occur in 1 in 10,000 women giving birth in the UK.’

‘The fact that the maternal mortality rate continues to come down at a time when we are seeing greater numbers of births in the UK and more complex pregnancies shows the dedication of so many doctors, nurses, midwives and other health professionals to improving maternity care.’

Professor Jennifer Kurinczuk, the National Lead for the MBRRACE-UK programme at the National Perinatal Epidemiology Unit added: ‘There is good news in this report: deaths are decreasing but there are still things we can do based on existing evidence-based guidelines. We owe that to the families left behind. We need to be able to say to the relatives of women who died that we are learning every lesson we can. Each woman included in this confidential enquiry was someone’s mother, daughter, sister, wife or partner. You can’t read all these stories and not be affected by them.’

This year’s report also highlights blood poisoning, or sepsis, and flu vaccination as areas where action could make a difference in reducing maternal deaths.

The researchers reviewed the care of women who died from sepsis and also women who survived an episode of septic shock. They emphasise the need for healthcare staff to ‘Think Sepsis’ at an early stage when seeing an unwell pregnant or recently pregnant woman. They say it is crucial that women with sepsis receive an early diagnosis, are put on antibiotics rapidly and that senior doctors and midwives are consulted quickly.

The group also states that increasing flu vaccination rates among pregnant women will save lives. One in 11 of the women who died had flu. And more than half of these deaths occurred after a flu vaccine was made available to pregnant women.

The report, called ‘Saving Lives, Improving Mothers’ Care: Lessons learned to inform future maternity care from the 2009–2012 UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity’, is published on Tue 9 Dec at a meeting at the Royal College of Obstetricians and Gynaecologists in London.

The enquiry was carried out through the MBRRACE-UK programme (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK) which is led from the National Perinatal Epidemiology Unit, Oxford University.

This is the 60th consecutive year in which the care of women who died during or after pregnancy has undergone detailed review in the UK. The aim is to learn what lessons are possible for improving care and recommend changes to reduce deaths in the future.

For the first time, the report includes the care of women in Ireland, and the care of women who survived severe illness and complications around the time of birth.

The MBRRACE-UK collaboration was commissioned in 2012 to carry out the UK Confidential Enquiries into Maternal Deaths and Morbidity by the Healthcare Quality Improvement Partnership (HQIP).

For more information please contact the University of Oxford news & information office on +44 (0)1865 280530 or news.office@admin.ox.ac.uk

Notes to editors:

* Table of causes of maternal deaths in 2006-2008 and 2010-2012

Cause of death

2006-2008

2010-2012

Number of deaths

Rate per 100,000 women giving birth

Number of deaths

Rate per 100,000 women giving birth

All deaths

261

11.39

243

10.12

Direct deaths

Genital tract sepsis

26

1.13

12

0.50

Pre-eclampsia and eclampsia

19

0.83

9

0.38

Thrombosis and thromboembolism

18

0.79

26

1.08

Amniotic fluid embolism

13

0.57

8

0.33

Early pregnancy deaths

11

0.48

8

0.33

Haemorrhage

9

0.39

11

0.46

Anaesthesia

7

0.31

4

0.17

Other

4

0.17

All direct deaths

107

4.67

78

3.25

Indirect deaths

Cardiac disease

53

2.31

54

2.25

Other indirect causes

49

2.14

61

2.54

Indirect neurological conditions

36

1.57

31

1.29

Psychiatric causes

13

0.57

16

0.67

Indirect malignancies

3

0.13

3

0.13

All indirect deaths

154

6.72

165

6.87

Coincidental

50

2.18

26

1.08

** The Maternal, Newborn and Infant Clinical Outcome Review Programme is run by MBRRACE-UK, a collaboration led from the National Perinatal Epidemiology Unit at the University of Oxford with members from the Universities of Leicester, Liverpool, Birmingham and University College London, as well a general practitioner, and Sands, the stillbirth and neonatal death charity.

***The Healthcare Quality Improvement Partnership (HQIP) is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. HQIP’s aim is to promote quality improvement, and it hosts the contract to manage and develop the Clinical Outcome Review Programmes, one of which is the Maternal, Newborn and Infant Clinical Outcome Review Programme, funded by NHS England, NHS Wales, the Health and Social Care division of the Scottish government, The Northern Ireland Department of Health, Social Services and Public Safety (DHSSPS), the States of Jersey, Guernsey, and the Isle of Man. The programmes, which encompass confidential enquiries, are designed to help assess the quality of healthcare, and stimulate improvement in safety and effectiveness by systematically enabling clinicians, managers and policy makers to learn from adverse events and other relevant data. More details can be found at: www.hqip.org.uk/clinical-outcome-review-programmes-2/

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